Development and initial psychometric evaluation of the Health Literacy knowledge and Experience survey for physical therapists (HLKES-2 PT)

Background Organizational health literacy – the ability of organizations to support individuals in finding, understanding, and using health information – underscores the role of healthcare professionals in effective communication. Physical therapists (PTs) who often work closely with patients managing chronic conditions are well-positioned to address health literacy (HL) challenges. As many U.S. adults experience HL barriers, PTs must prioritize HL strategies to improve outcomes and promote equity. However, research on PTs’ HL knowledge and practices is limited, highlighting the need for a tool to assess HL competencies in both PTs and physical therapy students and to inform targeted education and professional development.Aims This study aimed to adapt the HL Knowledge and Experience Survey (HLKES-2), originally developed for nursing, for use in physical therapy (HLKES-2 PT), evaluate its psychometric properties, and complete a validation study among licensed PTs and PT students. The goal was to provide a foundation for strategies to measure and improve HL knowledge and skills in PT education and practice.Methods The 14-item HLKES-2 was adapted for physical therapy, resulting in a 13-item tool with nine knowledge and four experience questions. Expert PTs reviewed the content for validity. The survey respondents included 216 licensed PTs and 45 third-year PT students from two Doctor of Physical Therapy programs. Item difficulty, discrimination, internal consistency, and demographics were analyzed using ANOVA, Chi-square, and Mann-Whitney U tests. Results. Licensed PTs had a mean knowledge score of 7.0/9 (78%), while students averaged 7.47/9 (83%). All knowledge items met acceptable difficulty thresholds, but six had low discrimination. Knowledge scale reliability was low (Cronbach’s α = 0.18); the experience scale was highly reliable (α = 0.96). No demographic variables significantly predicted knowledge scores among PTs, whereas practice area was linked to one experience item. Student knowledge scores differed significantly between programs.Discussion The HLKES-2 PT offers a preliminary tool for assessing HL knowledge and experience in PTs and students. Findings highlight the need to refine the tool for broader use in advancing HL competencies. The HLKES-2 PT lays the groundwork for future research and interventions to advance competencies in physical therapy.